Total joint arthroplasty for osteoarthritis (OA) is one of the medical miracles of the late 20th century. Unfortunately, the benefits seen are not equally distributed among ethnic minorities. The investigators' long-term goal is to understand the reasons behind the disparity in the use of joint arthroplasty between African-Americans and Whites. The objective of this five-year prospective cohort study is to determine whether ethnic variations in rates of joint arthroplasty can be explained by: a) Differences in the appropriateness of referral to the orthopedic surgeon (i.e., comorbidity, age, symptom severity, and adequacy of medical management) for joint arthroplasty, and/or; b) Differences in health beliefs about OA, and expectations following joint arthroplasty. Because referral to the orthopedic surgeon is the main avenue by which use of total joint arthroplasty is made available to patients with OA, they plan to recruit patients in the Primary Care Clinics of Wishard Memorial Hospital (County Hospital) and the Roudebush Veterans Administration Medical Center (VAMC). They will collect pertinent socio-cultural and clinical variables from patients at several time points during a two-year follow-up period. Referral status (whether referred or not referred) is their major outcome measure of interest. Because the decision to refer involves both the patient and the primary care physician (PCP), they will also survey the PCPs (as identified by their patients) concerning general attitude and knowledge about joint arthroplasty. As an outcome of the proposed investigation, they expect to identify factors associated with referral to an orthopedic surgeon and to determine if they explain the ethnic difference in referral rates for joint arthroplasty. The proposed study is significant because modifiable factors identified at the patient-PCP level may be amenable to educational or behavioral intervention which could eradicate ethnic disparity.